Long Term Evaluation of Direct Pulp Therapy–A Retrospective Study

Direct pulp therapy (pulp-capping) is defined as wound dressing of exposed vital pulp tissue, usually indicated due to pulp exposure through caries excavation or mechanical trauma. At present, treatment of pulpal exposures using this procedure remains a contentious clinical issue. A lack of standardisation in treatment criteria means that there is variation in: medicament choice; time elapsed prior to placement of the permanent restoration; and timing of review appointments.

Objectives:

To evaluate systematically the cumulative survival rate of direct pulp‐capped permanent teeth treated at the Sydney Dental Hospital between 2005‐2010.

Methods:

Records of patients treated at Sydney Dental Hospital with direct pulp therapy procedure carried out during the periods from 2005-2010 were retrieved. Patients without any follow-up record were invited to attend for clinical evaluation.

Direct pulp therapy was considered a failure where the tooth had been extracted, endodontic therapy undertaken, was negative to vitality testing or if apical rarefaction was detected.

Results:

Follow-up data was available for 280 patients. Pulp therapy medicaments used included Ledermix® cement, calcium hydroxide, and Mineral Trioxide Aggregate (MTA). Forty-five cases were regarded as successful, equating to 16% with 235 cases or 84% rated as failing (95% Confidence Interval 79-88%.) The survival rates of teeth treated with Ledermix® cement were 79 % at 3 months and 41% and 12 months. The majority of failures occurred between the ages 31-50 years and 51-70 years, 37.5% and 35.50% respectively.

Conclusions:

It was concluded, from this study, that the procedure of direct pulp therapy with Ledermix® cement is ineffective. The practice of Ledermix® pulp-capping should be reconsidered. Further research should be conducted into the use of MTA as a pulp-capping agent.